This Article  • Extract  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Gastrointestinal/ Upper Foregut  • Surgery, Other  • Alert me on articles by topic

Arch Surg. 2006;141:216.

Answer: Inverted Meckel Diverticulum
Helical computed tomography of the abdomen and pelvis after contrast shows the "target"-shaped area within 1 of the small-bowel loops, consistent with ileoileal intussusception (Figure 1). The patient underwent resection of the mass with an 8-cm margin from each side. The small bowel was then reconnected with a primary anastomosis. The patient was discharged home on postoperative day 4.

View larger version (69K): [in this window] [in a new window] Figure 1. Helical computed tomographic scan after oral contrast shows the characteristic "target"-shaped lesion within 1 of the distal small-bowel loops, indicating an ileoileal intussusception.

Pathologic examination of the specimen confirmed the diagnosis of inverted Meckel diverticulum with heterotopic pancreatic tissue and acute ischemic enteritis with serositis. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 2% to 3% of the population¹ and often asymptomatic. Clinical symptoms arise from complications, which occur in 4.2% to 6.4% of those harboring the diverticulum.^2-3 The lifetime risk of complications is likely independent of age, although they are more common in men than women.⁴

Intestinal obstruction is the most common complication in adults with Meckel diverticula.⁵ This may be caused by intussusception, volvulus, luminal obstruction from an inverted diverticulum, diverticulitis or a foreign body inside the diverticulum, inclusion of a diverticulum into a hernia, or neoplastic obstruction.

Heterotopic pancreatic tissue is found in 5% to 16% of resected Meckel diverticula.^6-7 The heterotopic pancreatic tissue may be located in the distal tip of the diverticulum and serve as a lead point for intussusception.

Only a few cases of inverted Meckel diverticulum have been reported.^{6, 8} Clinically, these patients present with bleeding, melena, and acute abdominal pain. Our case is unique because the patient presented with chronic diarrhea and intermittent abdominal pain.

Although a preoperative diagnosis of intussuscepted Meckel diverticulum has traditionally been based on an enteric contrast study or ultrasonography, computed tomography has been shown to be equally accurate if not more so.⁹ A classic feature of this ileoileal intussusception is the target lesion, which helped the diagnosis in this case.

AUTHOR INFORMATION

Jump to Section  • Top  • Answer: inverted meckel...  • Author information  • References

Correspondence: David Jacobsen, MD, Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.

Accepted for Publication: May 25, 2005.

REFERENCES

Jump to Section  • Top  • Answer: inverted meckel...  • Author information  • References

1. Moore TC. Omphalomesenteric duct malformation. Semin Pediatr Surg. 1996;5:116-123. PUBMED 2. Soltero MJ, Bill AH. The natural history of Meckel's Diverticulum and its relation to incidental removal: a study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period. Am J Surg. 1976;132:168-173. FULL TEXT | ISI | PUBMED 3. Cullen JJ, Kelly KA, Moir CR, Hodge DO, Zinsmeister AR, Melton LJ III. Surgical management of Meckel's diverticulum: an epidemiologic, population-based study. Ann Surg. 1994;220:564-569. ISI | PUBMED 4. Cullen JJ, Kelly KA. Current management of Meckel's diverticulum. Adv Surg. 1996;29:207-214. PUBMED 5. Fa-si-Oen PR, Roumen RM, Croiset van Uchelen FA. Complications and management of Meckel's diverticulum—a review. Eur J Surg. 1999;165:674-678. FULL TEXT | ISI | PUBMED 6. Pantongrag-Brown L, Levine MS, Elsayed AM, Buetow PC, Agrons GA, Buck JL. Inverted Meckel diverticulum: clinical, radiologic, and pathologic findings. Radiology. 1996;199:693-696. FREE FULL TEXT 7. Groebli Y, Bertin D, Morel P. Meckel's diverticulum in adults: retrospective analysis of 119 cases and historical review. Eur J Surg. 2001;167:518-524. FULL TEXT | ISI | PUBMED 8. Dujardin M, Op de beeck B, Osteaux M. Inverted Meckel's diverticulum as a leading point for ileoileal intussusception in an adult: case report. Abdom Imaging. 2002;27:563-565. FULL TEXT | ISI | PUBMED 9. Goldmann A, Haberle HJ, Wallner B, Schnarkowski P, Friedrich JM. Computed tomographic aspects of intestinal intussusception [in German]. Aktuelle Radiol. 1992;2:100-103. PUBMED

SECTION EDITOR: GRACE S. ROZYCKI, MD

RELATED ARTICLE

Image of the Month—Quiz Case
Amir Behdad, Rodney Chan, Ali Tavakkolizadeh, and David Jacobsen
Arch Surg. 2006;141(2):215.
EXTRACT | FULL TEXT